超声检查在无精症病因诊断中的应用价值

doi:10.16150/j.1671-2870.2023.04.006

摘要/Abstract

摘要：

目的： 探讨超声检查在无精症病因诊断中的应用价值。方法： 回顾分析2015年1月1日至2021年12月31日在我院确诊为无精症的连续病例314例，总结分析其临床资料及超声检查的结果。结果： 314例无精症患者中，梗阻性无精症(obstructive azoospermia，OA)患者118例（ 37.6%），非梗阻性无精症(non-obstructive azoospermia，NOA)患者196例（62.4%）。OA患者中，有89%（105/118）超声检查有阳性发现，包括先天性双侧输精管缺如（40例）、射精管梗阻（33例）、炎症性病变（17例）、钙化性病变（15例）；NOA患者中，有40.3%（79/196）超声检查有阳性发现，包括小睾丸（45例）、隐睾（13例）、睾丸微石症（16例）、精索静脉曲张（5例）。结论： 314例无精症患者中，NOA与OA之比为1.66∶1，经超声检查能明确其中58.6%患者的病因，能明确89%的OA病因及40.3%的NOA病因。

关键词: 超声检查, 梗阻性无精症, 非梗阻性无精症

Abstract:

Objective: To explore the application value of ultrasound in the etiological diagnosis of azoospermia.Methods: Three hundred and fourteen consecutive cases of azoospermia diagnosed in our hospital from January 1, 2015 to December 31, 2021 were retrospectively analyzed, and their clinical data and ultrasonic examination results were summarized and analyzed. Results: Among 314 patients, 118 (37.6%) had obstructive azoospermia (OA) and 196 (62.4%) had non obstructive azoospermia (NOA). Among OA patients, 89% (105 cases) showed positive ultrasound findings, including congenital bilateral vas deferens absence (40 cases), ejaculatory duct obstruction(33 cases), inflammatory lesions(17 cases), and calcified lesions (15 cases); Among 196 patients with NOA, 40.3% (79 cases) had positive ultrasound findings, including small testis (45 cases), cryptorchidism (13 cases), testicular microlithiasis (16 cases), and varicocele (5 cases). Conclusions: Among the 314 patients with azoospermia in this study, the ratio of NOA to OA is 1.66:1. Ultrasound examination is able to identify the etiology of 58.6% of the patients, including 89% of the causes of OA and 40.3% of the causes of NOA.

Key words: Ultrasonography, Obstructive azoospermia, Non-obstructive azoospermia

中图分类号:

姚世发, 陈萍, 李亮, 牛建梅. 超声检查在无精症病因诊断中的应用价值[J]. 诊断学理论与实践, 2023, 22(04): 369-373.

YAO Shifa, CHEN Ping, LI Liang, NIU Jianmei. Value of ultrasound in the etiological diagnosis of azoospermia[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(04): 369-373.

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参考文献 12

[1]	BABAKHANZADEH E, NAZARI M, GHASEMIFAR S, et al. Some of the Factors Involved in Male Infertility: A Prospective Review[J]. Int J Gen Med, 2020, 13:29-41. doi: 10.2147/IJGM.S241099 pmid: 32104049
[2]	邹义华, 陈善群, 陈晓峰. 经尿道射精管切开术联合精囊镜技术治疗射精管梗阻性无精子症(附22例报告)[J]. 中国内镜杂志, 2014, 20(1):80-83.
	ZOU Y H, CHEN S Q, CHEN X F. Combination of transu-rethral resection of ejaculatory duct with transurethral seminal vesicloscopy for treatment of azoospermia with ejaculatory duct obstruction (a report of 22 cases)[J]. China J Endoscopy, 2014, 20(1):80-83.
[3]	吴云剑, 董强, 李永忠, 等. 超声在梗阻性与非梗阻性无精子症鉴别诊断中的作用[J]. 四川大学学报(医学版), 2010, 41(2):344-347.
	WU Y J, DONG Q, LI Y Z, et al. The role of ultrasound in the differential diagnosis of obstructive and non-obstructive azoospermia[J]. J Sichuan Univ(Med Sci), 2010, 41(2):344-347.
[4]	杨黎明, 鲁红, 王军梅, 等. 近段输精管道获得性梗阻性无精子症经阴囊超声特征分析[J]. 上海交通大学学报(医学版), 2011, 31(4):466-469.
	YANG L M, LU H, WANG J M, et al. Scrotal ultrasonographic features of acquired obstructive azoospermia of proximal deferent duct[J]. J Shanghai Jiaotong Univ(Med Sci), 2011, 31(4):466-469.
[5]	SCHLEGEL P N, SIGMAN M, COLLURA B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I[J]. Fertil Steril, 2021, 115(1):54-61. doi: 10.1016/j.fertnstert.2020.11.015 pmid: 33309062
[6]	SCHLEGEL P N, SIGMAN M, COLLURA B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II[J]. Fertil Steril, 2021, 115(1):62-69. doi: 10.1016/j.fertnstert.2020.11.016 pmid: 33309061
[7]	PALTIEL H J, DIAMOND D A, DI CANZIO J, et al. Testicular volume: comparison of orchidometer and US measurements in dogs[J]. Radiology, 2002, 222(1):114-119. doi: 10.1148/radiol.2221001385 pmid: 11756714
[8]	中国医师协会生殖医学专业委员会生殖男科学组无精子症诊疗中国专家共识编写组. 无精子症诊疗中国专家共识[J]. 中华生殖与避孕杂志, 2021, 41(7):573-585.
	Chinese Expert Consensus Compilation Group of Azoo-spermia Diagnosis and Treatment, Reproductive Andro-logy Group, Reproductive Medicine Professional Committee of Chinese Medical Doctor Association. Chinese experts' consensus on the diagnosis and treatment of azoo-spermia[J]. Chin J Reprod Contracept, 2021, 41(7):573-585.
[9]	姜宏, 姜进军, 于洪娜, 等. 苗勒管囊肿与射精管囊肿的超声表现[J]. 中华医学超声杂志(电子版), 2006, 3(2):95-100.
	JIANG H, JIANG J J, YU H N, et al. Sonographic diffe-rentiation of Mullerian duct cyst and ejaculatory duct cyst[J]. Chin J Med Ultrasound (Electron Ed), 2006, 3(2):95-100.
[10]	TANG D, LI K, GENG H, et al. Identification of delete-rious variants in patients with male infertility due to idiopathic non-obstructive azoospermia[J]. Reprod Biol Endocrinol, 2022, 20(1):63. doi: 10.1186/s12958-022-00936-z
[11]	MARMAR J L. The pathophysiology of varicoceles in the light of current molecular and genetic information[J]. Hum Reprod Update, 2001, 7(5):461-472. doi: 10.1093/humupd/7.5.461 pmid: 11556493
[12]	王磊, 李凤华, 杜晶, 等. 经阴囊及直肠超声在无精子症鉴别诊断中的应用研究[J]. 中国超声医学杂志, 2009, 25(1):50-54.
	WANG L, LI F H, DU J, et al. Evaluation of azoospermia men with scrotal and transrectal ultrasonography[J]. Chin J Ultrasound Med, 2009, 25(1):50-54.

	Ultrasound findings		Number of cases	Percentage（%）
OA （n=118）	No abnormalities were found		13	11.0
	Abnormality
	CBAVD	With partial epididymis deficiency	20	17.0
		With bilateral seminal vesicle deficiency	5	4.2
		With bilateral seminal vesicle deficiency and partial epididymis deficiency	15	12.7
	Ejaculatory duct obstruction	Midline cyst of the prostate	23	19.5
		Ejaculatory ducts dilate	6	5.1
		Ejaculatory ducts Calcification	4	3.4
	Inflammatory lesions	Chronic epididymitis	17	14.4
	Calcified lesions	Epididymis Calcification	10	8.5
	Calcified lesions	Vas deferens calcification	5	4.2
NOA （n=196）	No abnormalities were found		117	59.7
	Abnormality
	Small testis		45	23.0
	Cryptorchidism		13	6.6
	Testicular microlithiasis		16	8.2
	Varicocele		5	2.6

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